During the 80's and 90's, many business transaction processing systems were focused on integrating business processes and data that existed within an organization (i.e., intra-organization). These systems cover a wide array of business applications, of varying complexity, including production forecasting/scheduling, order processing, human resources management, financial accounting, sales management, etc. Commercial examples of such systems include offerings from SAP, Oracle, and PeopleSoft. Organizations that successfully implemented such systems achieved reduced costs, higher efficiency, and were more competitive. With the intra-organization systems in place, these organizations are now looking to integrate the business processes and data that exist between trading partner organizations (i.e., inter-organization).
Today, most inter-organizational business transactions occur using paper as the primary medium of exchange. This process is characterized by a high degree of manual processing and lengthy transaction cycle times resulting in high costs, errors, and much inefficiency. In contrast, automating inter-organizational processing systems have demonstrated substantial benefits including greater efficiency, reduced costs, reduced transaction cycle times, and vastly improved management information.
For example, within many industries, numerous opportunities exist for automating the processing of inter-organizational business transactions, e.g., Insurance, Manufacturing, HealthCare, Banking, etc. Within the insurance industry, one such opportunity exists related to subrogation. Insurance subrogation is defined as the process by which one insurance company (demanding party) seeks reimbursement from another company (responding party) or person for a claim it has already paid. For more information related to subrogation, refer to the detailed description below.
Within most insurance companies, the subrogation function is not highly automated. Many of the larger carriers have implemented a rudimentary scoring system for identifying subrogation, but very few have implemented automation for enterprise-wide and inter-enterprise subrogation workflow. Paper and manual processes still dominate the subrogation business practices in use today.
Hence, there is needed in the marketplace an automated system with the following capabilities unique to inter-organizational business transaction processing: 1) a centralized network hub (web-based) that facilitates the inter-connection of various organizations and eliminates the proliferation of point-to-point interfaces, 2) an inter-organizational workflow management system that provides a common framework for managing the state and status of all transactions within the system, 3) an inter-organizational transaction processing component that supports multiple organizations and their distinct relationship with each transaction while also ensuring the security and privacy of each organization's data, 4) a unified data model mechanism that allows common data elements to be exchanged while also supporting organization specific interface requirements, and 5) application specific data and functionality specific to the types of business transactions being processed.
Furthermore, within the insurance industry, an inter-organizational system for subrogation claims is needed. Such a system would provide the application specific data and functions unique to insurance subrogation workflow.